Saving the Safety‐Net Hospital: Entangled Rhetorics of Life and Death in Hospital Advertising

AuthorLiz Hutter
Published date01 December 2019
Date01 December 2019
doi: 10.1002/wmh3.318
© 2019 Policy Studies Organization
Saving the SafetyNet Hospital: Entangled Rhetorics of
Life and Death in Hospital Advertising
Liz Hutter
This article examines the public discourse around Grady Memorial, a safetynet hospital in Atlanta,
GA, navigating financial vulnerability, its historical obligation to provide health care for the un-
derserved, and the conflicting needs of its diverse stakeholders. Using a rhetorical analysis I examine
the use of neardeath metaphors to frame the complexity and precarity of Gradys situation in coverage
of its nearclosure crisis in 2007 and in an iteration of its 2013 advertising campaign. The analysis
shows that while saving patientslives and saving the livelihood of healthcare institutions are
interdependent processes, the language and images used to talk about Grady prioritize its role as a
medical provider over its importance as a civic institution. In order to sustain both the medical and
civic support a safetynet hospital provides its community, an implication of the analysis suggests the
need for systematic research to understand stakeholdersattitudes and perceptions toward its health
care institutions.
KEY WORDS: hospitals, advertising, life saving
A prominent challenge in the current era of U.S. health reform is sustaining the
financial viability of safetynet hospitals, while also ensuring their commitment to
provide care for the vulnerable and underserved (Hall & Rosenbaum, 2012,
pp. 23). Collectively, in 2017, U.S. safetynet institutions provided $6.7 billion in
uncompensated care (Clark, Roberson, & Ramiah, 2019, p. 8); these institutions,
however, are burdened with operating margins totaling 1.6 percent and typically
do not generate large amounts of revenue (Clark et al., 2019, p. 8). With passage of
the 2010 Patient Affordable Care Act (ACA), some 20 million people have become
eligible for and acquired health insurance (Chokshi, Chang, & Wilson, 2016,
p. 1791). Under the ACA the cost of uncompensated care has decreased from $34.9
billion in 2013, to $28.9 billion in 2014 (Chokshi et al., 2016, p. 1790). Nonetheless,
when the ACA is fully implemented, an estimated 2831 million people will still
remain uninsured (Chokshi et al., 2016, p. 1791), particularly those unable to afford
high insurance premiums, the poor, underemployed people, and undocumented
immigrants (Bazzoli & Garland, 2012, p. 195). As implementation of the ACA un-
folds, shortterm stability and the longterm viability of the safetynet healthcare
system is of ongoing interest to researchers, policymakers, administrators, practi-
tioners, and community members.
This article examines Grady Memorial Hospital (hereafter referred to as
Grady), a 125yearold institution in Atlanta, GA, as an example of an urban safety
net institution managing its status as a financially strained, socially necessary
public healthcare institution. In 2007, Gradys crisis of near closure generated
intense public debate among the hospitals array of stakeholders regarding the
hospitals viability as a medical institution and its vitality as a prominent civic
institution in Atlanta. Although closure was averted when in 2008, the hospitals
leadership was transferred to a notforprofit corporate board, uncertainty about
the hospitals stability emerged again following passage of the ACA and Georgias
refusal of Medicaid expansion (Blau, 2013a, 2017).
Applying a rhetorical analysis to the representation of Grady in the news and
in its advertising, my analysis shows that saving the lives of patients and saving the
livelihood of healthcare institutions are interdependent processes. I argue that the
metaphors used in the news and in the hospitals advertising to frame Gradys
crisis can shape how the hospitals political, economic, and community stake-
holders understand the complexity of Gradys problem, and in turn, determine
what interventions to use to address it. Framing Gradys nearclosure crisis as a
metaphor of surviving near death orients public dialogue to prioritize financial
interventions as the necessary solution to restoring the stability of the hospitals
operations. Alternately, when the crisis is framed as a metaphor of thriving near
closure, stakeholders recognize Gradys survival is dependent on numerous factors
that include maintaining a steady revenue stream as well as supporting dedicated
urban infrastructure to care for the citys current and future residents. An im-
plication of my analysis is to suggest that cultivating more inclusive stakeholder
dialogue and examining more systematically a communitys attitudes and per-
ceptions toward its public healthcare institutions can guide researchers, policy-
makers, and legislators to develop different interventions to save the hospitals
financial viability, while sustaining its role in the lives of Atlantas diverse
To develop my analysis, I first provide an overview of the financial and social
pressures Grady faced in 2007, in order to show the complexity or wickedness of
Gradys situation. I then examine the biomedical and biosocial metaphors of sur-
vival in news coverage of the hospitals crisis and in the hospitals 2013 iteration of
its I cant live without Gradyadvertising campaign. The paper concludes with a
recommendation for researchers and policy makers to seek pathways to better
understand not just the financial dilemma of safetynet hospitals, but to also ex-
amine the perception of these institutions as valuable civic institutions essential to
all of a citys residents.
Defining Grady Hospitals Financial and Social CrisisA Wicked Problem
Grady Memorial, ranked within the top 10 largest U.S. public hospitals, man-
ages an operating budget that averages annually $760 million and supports more
than 30,000 adult admissions, 312,000 outpatient visits, and 141,000 emergency
room visits (Grady Fast Facts,n.d.). With over 950 beds, Grady anchors the
Hutter: Saving the SafetyNet Hospital 341

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